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Saturday, May 7, 2016

Why regulations increase healthcare costs copy

There have been accusations, including some by our president, that doctors sometimes order procedures just to make a profit. For instance, that doctors are more likely to cut out tonsils, or cut off legs, or perform c-sections, just because these make more money and are easier than trying to find out why the tonsils are swollen, why a leg is rotting off, or waiting for birth to be natural.

They say the cure for this is supposed to be government run healthcare and not for profit healthcare, as these evils are the result of capitalism.

Yes, if you are a doctor, and you are cutting out tonsils or cutting off legs just to make a profit, than you are a despicable doctor. Still, government run healthcare will not solve this problem, only make them worse. I can give you some real life examples to make my point.

According to modern healthcare regulations, if you come to the emergency room with generic dyspnea, and the doctor even thinks you should be admitted, you will receive three breathing treatments. This is because, if you don't need at least three breathing treatments, then you aren't sick enough to be admitted and therefore do not meet criteria for admission nor for reimbursement.

The same is true once you are admitted. One of the best ways to assure reimbursement criteria is met is to order breathing treatments on a frequency, such as Q6 or QID. This way an auditor can looking back on the patient's stay and see that, well, at least the patient was sick enough to need breathing treatments. So, he must have been sick enough to be admitted. So, in that case, we will reimburse the hospital.

Okay, so this is true whether breathing treatments are needed or not. Breathing treatments cost over $100 each, and therefore rack up quite a hefty charge. You add into this other procedures that are ordered just so the hospital meets criteria, and this adds up to a lot of money. And you know who eats this charge? Hint, it's not the insurance companies nor the government. It's the hospital. This is because the hospital is reimbursed per diagnosis and not by procedure.

However, to assure reimbursement criteria is met, these procedures must be ordered. I know this sounds silly, but it's the way it is in our current healthcare system. This might explain why some patients receive breathing treatments even when they admit themselves that they are breathing fine and question the need. But, because the doctor ordered it, they don't refuse. Of course this would be different if they were paying the bill and not a third party.

There's one other not anticipated aspect of Obamacare. The authors did not expect that hospitals would actually hire people to make sure the above is done. These people, what I like to call Obamacare workers, go over charts to make sure the correct diagnosis is written, and to make sure enough procedures are ordered (like breathing treatments for pneumonia, even though breathing treatments do nothing for pneumonia, but I won't rock that boat again).

And when they see a diagnosis the doctor did not write, one that would charge better, they (the Obamacare workers) call the doctor and tell them to write it. When they see breathing treatments aren't ordered, the call to get the order. This is what they do.

This is how hospitals operate today. It's crooked. It's seems like fraud to my friends and me, but it's the way it is. It's even heralded as good. It explains why doctors who have historically fought cookbook medicine (treating all patients the same) now support them. And, to be honest, I don't think most doctors support order sets that order doctors what to order. I think they have just conformed out of need to get paid and keep their jobs. But I digress.

These Obamacare workers make a lot of money. And when you figure that over 30 of them work at every hospital, this adds to the cost of medicine. So in order to pay for all these extra workers, hospitals have to make choices. They have to cut back on the number of nurses they hire, or pay lower wages and salaries, or raise prices. Yes, they have to raise prices. They have to charge higher prices for all those frivolous breathing treatments, or those not needed EKGs or X-Rays to make a profit. I mean, there's more to it that what I describe here, but that's the jist of it.

So, in this way, government healthcare raises healthcare costs, it does not lower them.